Can Lowering Blood Pressure Reduce Dementia Risk?

Of all the things people worry about as they get older, losing their memory is usually near the top of the list. Heart attacks and strokes are frightening. But the thought of slowly losing yourself is a different kind of fear.

So I want to share some hopeful news. One of the best tools for protecting your brain may already be sitting in a drawer at home: a blood pressure cuff.

A large trial presented this fall at the European Society of Cardiology's annual meeting followed nearly 34,000 adults with high blood pressure for seven years. The trial found that controlling high blood pressure lowers the risk of dementia.  Specifically, bringing blood pressure down toward 130/80 reduced the risk of dementia by 15%, and cut cardiovascular events at the same time.

To me, this is a very encouraging finding. We have no cure for dementia. We have very few ways to prevent it. Controlling blood pressure appears to be one of them, and it's something we can actually do.

What Did the Blood Pressure and Dementia Study Find?

The trial, called CRHCP, took place in 326 rural villages in China. The participants were 63 years old on average, and 61% were women.

Half of the villages got a structured program. Village health workers, trained and supervised by doctors, started and adjusted blood pressure medications using a simple step-by-step plan, with a goal of getting blood pressure below 130/80. The other half got their usual care.

The program ran for four years. Then the researchers stepped back and simply watched for three more.

At seven years, systolic blood pressure (the top number) had come down by 17.6 points in the program group, compared with just 2.4 points with usual care. Dementia was diagnosed in 8.85% of the program group versus 10.55% of the usual care group. That's a 15% lower risk. Milder problems with memory and thinking, the kind that hadn't yet reached the level of dementia, were 13% lower, too.

The same program also lowered the combined rate of heart attacks, strokes, heart failure and cardiovascular deaths. Additionally, serious adverse events were slightly LESS common in the program group, not more.

Two important points to make here. The 15% reduction in dementia rates was seen at the end of the 4 year intervention already. And the benefit held during the three years after the program's support ended. Blood pressure stayed lower, and so did the risk.

Why Does High Blood Pressure Affect Your Brain?

Think of blood pressure as a hammer striking your arteries, accelerating the wear and tear. The higher the pressure, the more damage - disproportionately affecting the smallest most delicate blood vessels which are most prone to injury.  A lot of those tiny arteries happen to be in your brain.

High blood pressure:

• Thickens and stiffens the walls of small arteries, so less blood gets through to brain tissue.
• Causes tiny, silent strokes that don't produce symptoms on their own but add up over time.
• Wears down the protective lining of the brain's blood vessels, the barrier that keeps harmful substances out.

We've known for decades that high blood pressure raises the risk of dementia. What's been harder to prove is that lowering it actually prevents dementia. That's what makes this trial matter. It's also why the most recent U.S. blood pressure guidelines recommend keeping the top number below 130 mmHg.

Is Blood Pressure Medication Good for Your Brain?

In this trial, it was. The program worked by getting people on the right medications, at the right doses, and keeping them there. If you've ever worried that blood pressure pills might be harmful, this is strong evidence in the other direction.

There was one trade-off. People in the program group had more episodes of low blood pressure, which can show up as dizziness or lightheadedness when you stand. That's a reason to reach your target with your doctor's guidance and to speak up if you feel woozy.  It's not a reason to avoid treatment.  

Are there any caveats to keep in mind? Yes. The study was done in rural China, where many people started out with high blood pressure that had never been treated. So the results may not translate perfectly to other populations living in different circumstances.  But the combination of a large randomized trial, a result repeated at four and seven years, and a benefit that lasted after the formal intervention ended is hard to ignore.

What Blood Pressure Should You Aim For?

For most adults, under 130/80. That's the target in the current guidelines, and it's the same target this trial used. The only way to know where you stand is to measure. Readings in a doctor's office can run high (or low), so a validated home cuff, used at the same time of day, gives you and your doctor a much clearer picture. Here's how to measure your blood pressure at home the right way.

How Can You Lower Your Blood Pressure?

Medication was the engine of this trial, and for many people it's absolutely the right tool. But it isn't the only one, and all medications work better when you do your part.

Losing extra weight, eating a plant-forward, DASH-style diet, cutting back on sodium, moving most days and limiting alcohol each bring blood pressure down, and their effects add up. I walk through the full playbook in how to lower blood pressure naturally. 

Helping yourself can be truly impactful - after all, every point you take off with lifestyle is a point you don't need a pill for. But if you're already on medication, please don't stop or adjust it on your own. Make that call with your doctor, using your home readings. 

I built Step One Foods to make the food part easier: two servings a day, low in sodium and plant based, very much in line with the DASH approach, delivering soluble fiber, plant sterols, antioxidants, and unsaturated fats. In our clinical trial, 80% of participants lowered their LDL in just 30 days. The trial was not designed for blood pressure lowering - but we hear frequently from customers that their blood pressure is better too.  

What's good for your heart has always been good for your brain. Now we have the numbers to prove it.

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